Pneumonia Prevention

PNEUMONIA PREVENTION

In this article we are going to discuss pneumonia prevention and epidemiology. According to World Health Organization (WHO), globally pneumonia is the leading cause of death in children. It is killing approximately 1.2 million children under the 5 years of age annually, which is greater than malaria, tuberculosis and AIDS combined. In developing nations, such as Pakistan, 1 in every 5 children dies of pneumonia.

PNEUMONIA IS THE MOST COMMON INFECTION ENCOUNTERED BY THE EMERGENCY DEPARTMENT AS WELL AS PRIMARY CARE CLINICS. IN THE DEVELOPED COUNTRIES IT IS THE LEADING CAUSE OF MORBIDITY. HOWEVER, MORBIDITY RATIO HAS DECLINED DUE TO NEW VACCINES, IMPROVED MONITORING AND DIAGNOSTIC TECHNIQUE (PEREDA ET AL., 2015).

Infection Cause

The infection is caused by a large variety of micro-organisms, ranging from viruses to bacteria and fungi. The etiology of pneumonia depends on the age of the patient. In neonates, maternal flora, like B streptococcus, are commonly transmitted vertically. Overall, Streptococcus pneumonia is the most common bacterial agent that causes pneumonia, whereas 14% to 35% cases are viral (Lynch III and Zhanel, 2010, Pereda et al., 2015).

Pneumonia Prevention

Pneumonia Prevention

Pneumonia can be prevented by adopting some of the very simple habits which include:

Get Vaccinated

Get flu shots annually to prevent influenza, which is a common risk factor for pneumonia development. Pneumococcal conjugate vaccine should be administrated specially in children younger than 5 and adults elder than 65 years of age. This will be the key for pneumonia prevention.

Wash Your Hands

Wash hands frequently specially after blowing your nose, diapering, coming from toilet and before eating and preparing food.

Don’t Smoke

Tobacco damages your lung’s ability to fight off infection. So, smokers are considered one of the high-risk groups and are encouraged to get the Pneumococcal vaccine.

Be Aware of Your General Health

Since pneumonia often follows respiratory infections, be aware of any symptoms that linger more than a few days. Good health habits prevent sickness from viruses and respiratory illnesses. They also help promote fast recovery when you do get a cold, the flu or other respiratory illnesses.

Stay healthy, Stay Happy!

Epidemiology and Mortality in Pakistan

As has been discussed earlier, no exact epidemiology of the disease can be established due to lack of appropriate relevant data. However, from the courses available to us a few conclusions have been drawn. The infant mortality rate in Pakistan is 59.3 death/1000 live births. Due to such a high mortality ratio, Pakistan is placed on position 2009). 55 w.r.t to infant mortality. One half of these are caused by pneumonia. (Jehan et al.,

Pneumonia Prevention

American Journal of Infection Control Study on Pneumonia

A study published in the American Journal of Infection Control suggests that there are no reports on the number of hospital acquired cases of pneumonia. While incidence of ventilator associated pneumonia is 55% with a mortality rate of 58%. A few of the studies on Community Acquired Pneumonia (CAP) have been added or an idea of the current etiology and mortality in the country.

Between the year 2002 and 2003, the first lab-based observational study was conducted in Rawalpindi. This study revealed a low diagnostic yield (17.25%) for the pathogens that were isolated. Hence, the most commonly identified pathogen was Haemophilus influenza. Also, this yield has been reported in most of the pediatric populations (41/64) (Butt et al., 2005).

International Survey

Another study was conducted as a part of the international survey that consisted of 9 countries. 200 samples from Pakistan were included, and Haemophilus Influenza and streptococcus pneumonia were equally detected (Zafar et al., 2008).

Observational Retrospective Study

Observational retrospective study, which was conducted in a tertiary care hospital include radiological as well as clinical presentation along with lab investigations in order to evaluate the mortality in patients suffering from CAP, 11% mortality rate was observed. However, complications such as septic shock, multiple organ failure, ARD, ventilator were linked to high rate of mortality. In case of microbiological specimens, low yield was observed, due to the unavailability of serologic test for atypical pathogens (Irfan et al., 2009).

Other Studies

Another original retrospective study conducted at a tertiary care hospital, specifically for the S. pneumonia positive samples, two years of medical data was reviews. The sample size was 16785, of which only 0.7% showed S. pneumonia as the causative agent.

However, a wide variety of limitations were linked with this study. The study was conducted at a single centre that has a very low isolation rate. Age variation of the patients tested positive was quite high-ranging from 2 months – 75 years. Due to these limitations, conclusions for the entire population cannot be derived (Choudhry et al., 2011).

Predesigned Study

Another group of researchers conducted a questionnaire based pre-designed study to assess their demographic profiles at the tertiary care centre in Bahawalpur on 150 hospitalized patients of CAP. The striking feature of this study was that it was conducted in rural Punjab, where most people were of a low socio-economic class and illiterate. Hence interestingly in this study, the age group most affected was that of 20 to 40 years.

Other Local Studies

124 patients were enrolled in another study, that identified etiologic agents 41.93% cases, of which, 69% were found to be Chlymadia and Myoplasma pneumonia. However, such a trivial number of microorganism identified in the routine study do not show the true picture of pneumonia etiology in Pakistan (Ansarie and Kasmani, 2014).

Furthermore, a retrospective study conducted from 2002 till 2008 to identified etiology of severe community-acquired pneumonia (SCAP) in adults in accordance with ATS guidelines 2001. Out of 832, 9 were CAP effected while 189 suffered from SCAP of which 179 needed ICU and only 10 could be managed in the ward. The pathogen identified was 15.85 S. aureus, 14.7% S. Pneumonia and 9.5% P. aeruginosa. Pakistan chest society guideline has a document that was also initially published by the pneumonia guideline community. Taking into consideration the etiologies that are most commonly identified; PCS classified treatment based on British Thoracic Society and American Thoracic Society recommendations.

Pneumonia causes are recorded in the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys of the United Nations Children Fund (MICS); but due to the nonspecific classification of the pneumonia cases countrywide the number generated are not 100% accurate. The estimates for the annual incidence of the Acute Respiratory Infections (ARI) in Pakistan for children under the age of 5 is just for a group that is representative of just 22% of the population. Finally, most of the studies on the Asian continent with reference to pneumonia, its pathogens, prevalence and epidemiology report lack of data from Pakistan (Hazir, 2008).

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